ESPE Abstracts

Background: Although Ramadan fasting is one of the five pillars of Islam and is compulsory for all healthy Muslims from puberty onwards, religious exemptions exist for patients with type 1Diabetes. The risks of fasting include: hyperglycemia, hypoglycemia, ketoacidosis, thrombotic episodes, and dehydration. Many adolescents still insist to fast due to religious or social motives.

Objectives: To study the risks and metabolic consequences of Ramadan fasting among Egyptian adolescents with Type I diabetes mellitus (T1DM) who insisted to fast

Methodology: This was an observational case-control study (retrospective clinical and laboratory data from files and hospital records before Ramadan as well as prospective follow up clinical and laboratory data of patients after Ramadan). This study was conducted on a total of 109 adolescents with type 1 diabetes patients; the fasting group included 76 patients while, the non- fasting group included 33 patients. Serum HBA1c and Fructosamine were assessed before and after fasting.

Results: Hyperglycemia was the most common complication as it was experienced in 66(86.8%) patients in the fasting group and in 24(72.7%) patients in the non-fasting group. Hypoglycemia occurred in 60(78.9%) patients in the fasting group compared to 24(72.7%) patients in the non-fasting group. DKA developed in 15(19.7%) patients during Ramadan and 17(22.3%) patients during Shawal in the fasting group while none of the non- fasting group developed DKA and dehydration during Ramadan or Shawal (P=0.003 and 0.009 respectively). Serum fructosamine was significantly higher in the non-fasting group compared to the fasting group after Ramadan (P = 0.002). Fasting had adverse changes also on lipid profile.

Conclusion: Type 1 Diabetic children and adolescents should be considered high risk or very high risk for fasting. Those who insist to fast during Ramadan should seek medical advice concerning the risks involved and should be warned against fasting. Fasting was associated with significant increase in frequency of acute complication; hyperglycemia, hypoglycemia, DKA and dehydration. Fasting also had negative impact on glycemic control represented by HbA1c and on lipid profile as both were significantly deteriorated after Ramadan fasting. These effects were mostly due to wrong dietary habits during Ramadan, improper administration of insulin and lack of commitment to different advices given during the pre -Ramadan education sessions. Moderate or low risk are well controlled type 1 DM patient, using insulin pump and or CGM with compliance and strict follow up and time in range: 70% or more